Jeffrey D. Sachs, Professor of Sustainable Development, Professor of Health Policy and Management, and Director of the Earth Institute at Columbia University, is also Special Adviser to the United Nations Secretary-General on the Millennium Development Goals. His books include
The End of… read more

Aid Works

NEW YORK – The critics of foreign aid are wrong. A growing flood of data shows that death rates in many poor countries are falling sharply, and that aid-supported programs for health-care delivery have played a key role. Aid works; it saves lives.

One of the newest studies, by Gabriel Demombynes and Sofia Trommlerova, shows that Kenya’s infant mortality (deaths under the age of one year) has plummeted in recent years, and attributes a significant part of the gain to the massive uptake of anti-malaria bed nets. These findings are consistent with an important study of malaria death rates by Chris Murray and others, which similarly found a significant and rapid decline in malaria-caused deaths after 2004 in sub-Saharan Africa resulting from aid-supported malaria-control measures.

Let’s turn back the clock a dozen years. In 2000, Africa was struggling with three major epidemics. AIDS was killing more than two million people each year, and spreading rapidly. Malaria was surging, owing to the parasite’s growing resistance to the standard medicine at the time. Tuberculosis was also soaring, partly as a result of the AIDS epidemic and partly because of the emergence of drug-resistant TB. In addition, hundreds of thousands of women were dying in childbirth each year, because they had no access to safe deliveries in a clinic or hospital, or to emergency help when needed.

These interconnected crises prompted action. The United Nations’ member states adopted the Millennium Development Goals in September 2000. Three of the eight MDGs – reductions in children’s deaths, maternal deaths, and epidemic diseases – focus directly on health.

Likewise, the World Health Organization issued a major call to scale up development assistance for health. And African leaders, led by Nigeria’s president at the time, Olusegun Obasanjo, took on the challenge of battling the continent’s epidemics. Nigeria hosted two landmark summits, on malaria in 2000 and on AIDS in 2001, which were a crucial spur to action.

At the second of these summits, then-UN Secretary-General Kofi Annan called for the creation of the Global Fund to Fight AIDS, TB, and Malaria. The Global Fund began operations in 2002, financing prevention, treatment, and care programs for the three diseases. High-income countries also finally agreed to reduce the debt owed by heavily indebted poor countries, allowing them to spend more on health care and less on crippling payments to creditors.

The United States also took action, adopting two major programs, one to fight AIDS and the other to fight malaria. In 2005, the UN Millennium Project recommended specific ways to scale up primary health care in the poorest countries, with the high-income countries helping to cover the costs that the poorest could not pay by themselves. The UN General Assembly backed many of the project’s recommendations, which were then implemented in numerous low-income countries.

Donor aid did start to rise sharply as a result of all of these efforts. In 1995, total aid for health care was around $7.9 billion. This inadequate level then crept up slowly, to $10.5 billion by 2000. By 2005, however, annual aid for health had jumped another $5.9 billion, and by 2010, the total had grown by another $10.5 billion, to reach $26.9 billion for the year.

The expanded funding allowed major campaigns against AIDS, TB, and malaria; a major scaling up of safe childbirth; and increased vaccine coverage, including the near-eradication of polio. Many innovative public-health techniques were developed and adopted. With one billion people living in high-income countries, total aid in 2010 amounted to around $27 per person in the donor countries – a modest sum for them, but a life-saving one for the world’s poorest people.

The public-health successes can now be seen on many fronts. Around 12 million children under five years old died in 1990. By 2010, this number had declined to around 7.6 million – still far too high, but definitely an historic improvement. Malaria deaths in children in Africa were cut from a peak of around one million in 2004 to around 700,000 by 2010, and, worldwide, deaths of pregnant women declined by almost half between 1990 and 2010, from an estimated 543,000 to 287,000.

Another $10-15 billion in annual aid (that is, roughly $10-15 more per person in the high-income world), bringing total aid to around $40 billion per year, would enable still greater progress to be made in the coming years. The MDGs for health could be achieved even in many of the world’s poorest countries.

Unfortunately, at every step during the past decade – and still today – a chorus of aid skeptics has argued against the needed help. They have repeatedly claimed that aid does not work; that the funds will simply be wasted; that anti-malaria bed nets cannot be given to the poor, since the poor won’t use them; that the poor will not take anti-AIDS medicines properly; and so on and so forth. Their attacks have been relentless (I’ve faced my share).

The opponents of aid are not merely wrong. Their vocal antagonism still threatens the funding that is needed to get the job done, to cut child and maternal deaths by enough to meet the MDGs by 2015 in the poorest countries, and to continue after that to ensure that all people everywhere finally have access to basic health services.

A decade of significant progress in health outcomes has proved the skeptics wrong. Aid for health care works – and works magnificently – to save and improve lives. Let us continue to support these life-saving programs, which uphold the dignity and well-being of all people on the planet.

Comments

A NEW DYNAMIC FOR AIDby Nirmalan Dhas on Thursday, January 5, 2012 at 4:12am ·

The Context

The world we live in is not the world into which we were born. It is a hotter world where floods, fires, tsunami, earthquakes and other sudden and unannounced disasters are increasing in their frequency. It is a world in which these sudden disasters cause billions of dollars worth of damage that take years to re build and draw heavily on already scarce resources.

The world we live in is a world challenged by Rapid Resource Depletion (RRD), Pollution and Global Climate Change (P&GCC), Global Monetary Collapse (GMC) and the increasing incredibility of the Growth Model of Development (GMD) and the very nature of aid has to change in response to these hitherto ignored phenomena.

Our models of aid are old and outdated and do not meet the requirements of the world we live in today and the one we are likely to make for ourselves tomorrow…

Humanitarian Aid

Humanitarian Aid was never designed to respond to the kind of disasters that we have faced in recent times and will likely face more frequently in the future. Humanitarian aid has always been emotionally driven and this emotional drive rests on the understanding that disasters are random un related events to the occurrence of which we contribute nothing and whose victims are in effect the victims of misfortune and therefore worthy of the sympathetic assistance of those who have not thus been afflicted. But today we are all afflicted by these four dynamics that have arisen out of our own greed based and desire driven actions over the last two centuries or so and there is no one who stands un affected and in a position to sympathize with us and help us.

We have to prepare to help ourselves and so humanitarian aid must be transformed into a component that responds to emergencies within a larger process that is consciously engineered to engage the disasters that appear to lie ahead and mitigate their impact with the clear and conscious objective of ensuring the survival of as many human individuals as possible so that the human species itself may survive and regenerate itself.

The human species cannot however survive or regenerate itself without ensuring the survival of its environment and its regeneration as well as ensure the survival of life on Earth, as we know it. The survival of the human species, the survival of life as we know it on Earth and the survival of the planetary environment, cannot be looked at separately but as a single indivisible whole.

Development Aid

This would render our growth model of development both destructive and dangerous so that our development aid would then have to be a holistic process that devotes the bulk of energy and resources to environmental repair and regeneration while channeling a significant quantum into research into new less dangerous technologies and into the designing of new ways to live, new habitats, new relations with food and nutrition, new ways of enhancing human health and wellness, new attitudes to death and new ways by which human knowledge can be passed down generations.

Initially and for a very long time to come, a large amount of development aid will have to be devoted to disaster forecasting and warning systems, community training in disaster mitigation, the preparation of responses to likely disasters and the maintenance of stockpiles of food water and medicines as well as the training of communities in new ways of living and relating to each other for survival.

Aid re-conceptualized

As you can see, within this context aid ceases to be aid and becomes instead a vital component of the emerging model of development. It ceases to be a "one third of one percent" effort and instead it becomes the central force of the drive to ensure the survival of the human species and it is generated not by emotion but by clear and calm perceptions of what has occurred and what lies ahead of us and how we may respond with the objective of ensuring the survival of our human species.

The understanding of this need for change is what we must bequeath the young of our species. We must ensure that the wisdom we have gathered through the eons of evolution of our species in the course of which so much energy has been expended and so many resources consumed must be handed over to them. Wisdom must become the mark of youth so that our young may survive the turbulence ahead.

We have perhaps clumsily and perhaps crudely and perhaps blindly and perhaps unthinkingly clawed our way along the evolutionary pathways we were able to perceive until today at least some of us are able to perceive the price we have paid and the price we may be called upon to yet pay and who know that the extinction of the human species within whom such a high level of autonomy has been evolved, and life as we know it on earth and earths planetary environment which generates and sustains such life, cannot be permitted.

The new developmental mission

Life as we know it on earth can survive to continue its evolution through and beyond human being and to spread throughout the universe. It is up to us to ensure that it is facilitated in its attempts to survive and realize its potential to do so.

Our context now demands much more than the Millennium Development Goals. It demands that we concentrate our every effort on the survival of our species and the survival of all that its survival requires.

Although you cite many impressive figures to do with falling child mortality and fewer deaths of women during childbirth, to a certain extent the gains will surely be harder to maintain in the future. In a sense the development you describe must be the result of plucking low hanging fruit. For example mosquito nets can be manufactured and distributed fairly cheaply let yield large immediate falls in cases of malaria. However the only way that developing countries can truly become developed countries and sustain the gains made so far is with effective governance and the right economic and social policies in place. These vital factors are sadly lacking in many poor areas of the world. Hence although aid definately helps, it cannot act as a substitute for good governance.

I agree with Prof.Sachs argument that aid works but it is also true that in some situations/conditions it does not worked as well...Research shows both positive and negative outcomes of aid..But this does not favor giving up aid..What's important is,to go after some particular characteristics/political factors which determine the outcome of aid process...after all we are talking about life and death here..so i don't think it gives us other choice than how to work aid..

The point behind Prof Sachs's piece is that aid has worked. It has worked not only in his illustrated area of health care, but in emergency food supplies, food security, education, infrastructure, water and sanitation, training, capacity building and more. Given limitless space he could have detailed all these. And yes, aid dollars have to be spent effectively. But the contention he is battling is the simple claim that 'Aid does not work'.

That claim is not only wrong, it is often promoted selfishly and endangers the lives of the most vulnerable and the security of us all.

NB. My views are my own and do not necessarily reflect those of my employer.

I almost agree with the title, but not with professor Sachs' choice of content. Two points to illustrate this:

1. The title reads: "Aid Works" but the last paragraph reads "aid for health care works". What is being discussed is not all of aid, but aid to health care, and specifically aid to health care to reach MDGs. This is fine if it worked as an in-depth example illustrating a larger point, but I am unsure to what extent the argument on effectiveness applies in all other development contexts.Health care is relatively 'simple' in that it has a fixed logic and obvious end goal: 'diseases are detrimental to humanity, therefore they must be eradicated'. But not all issues in development have this basic normative line. Debates on democracy are far from over, and there is no consensus on an end goal to economic development (growth or redistribution?). Given this, the solution that aid brings is not always found in the aid money, as the health care example in this article by and large illustrates.

2. Aid is not necessarily aid money, and I wish professor Sachs made this distinction much clearer. Professor Sachs' argument would be much stronger if he included more examples of effective aid that cannot be put into dollar amount (the UN Millennium Project is one good example cited). One wouldn't tell by reading the article that policy planning, strategy, creative problem solving and knowledge sharing can all be forms of aid.

There is much to be said for how effective aid money to certain projects and in certain areas can be. But putting the emphasis on the quantitative side of things, while useful, can be distracting.With last year's Busan High Level Forum on Aid Effectiveness and with the upcoming Rio+20 summit, the logic is not, as professor Sachs suggests 'Aid works. So are we giving enough money?'. Rather, the logic is 'Aid _can_ work. How effective is it? What is the future of cooperation for development?'

Unfortunately, appart from studies on malaria, Professor Sachs does not provide any evidence that decline in mortality in developing countries is actually due to increased funding and aid by rich countries... Who can prove that the good news (evidence should also be found: e.g. when we notice that immunization coverage in several districts exceeds 100%, we should seriously question data reliability...) can not be explained more generally by an improvement of basic hygiene & sanitation and economic development of these countries (which assign an increasing share of national budgets to health)?

In addition, the Health MDGs are far from being met by 2015 and most experts in international health acknowledge this unfortunate perspective. Dr. Margaret Chan herself expressed some concerns during the last WHA which ended a few days ago...

Alberto Bagnai, ET AL
want the Greek government to abandon the euro – and all other eurozone members to follow suit.

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